Living Donor Liver Transplant: Is it Appropriate for Patients in Critical Need?
Living donor liver transplant offers some patients a speedier alternative to waiting for a deceased donor liver. Patients generally have a shorter waiting period and experience fewer health complications if a living donor option exists. You and your medical team are able to select the ideal timing of your surgery. If your situation is urgent, however, a living donor liver transplant might not be the best option for you.
Each patient is different, so you will need to meet with your medical team to determine if living donor transplant is best for you, but here are some general ideas about who should and should not pursue living donor liver transplantation:
In cases where a transplant is needed urgently, the patient is very sick and may not live more than a few days without transplant. This urgency also may not give the care team or the potential living donor enough time to evaluate and fully consider the situation prior to donation. Becoming a living donor is a big commitment in a person’s life. The donor needs time to thoughtfully consider their situation and the surgery to be sure donation is the right choice for them. Urgent cases may not provide enough time for all of these necessary steps to occur. Luckily, these urgent patients are given a priority to receive deceased donor livers.
High MELD Scores
Patients with high MELD scores, for example in the 30s or 40s, are more likely to get a deceased donor liver transplant than patients with lower scores. These patients’ scores are high because they are very sick, and this situation requires careful discussion with the care team to decide if living donor transplant is optimal. In addition, with a very sick patient, sometimes the need for a whole liver, and not a partial liver, is more important because the patients are less likely to be able to tolerate the time period for liver regeneration.
Sick Patients with Lower MELD Scores
While the MELD score is used to identify patients who are sick and need a transplant sooner, they sometimes don’t accurately reflect the patient’s need for a liver transplant. Examples include patients needing frequent tap or removal of ascites fluid or patients with frequent hospital admissions for confusion. These complications often do not raise the MELD score but still depict a greater need for transplant. Another example of patients who may benefit greatly from living donor transplant are those who have liver cancer or cancer in their bile duct. They may have a long wait for a deceased donor liver. These patients would benefit from a living donor transplant, because they would be able to receive their transplant before their tumors grow, and before they become too sick for transplant surgery.
Alcoholic Liver Disease Patients
Most transplant centers, including Mayo Clinic, require patients to be alcohol free prior to being placed on the transplant waiting list and prior to living donor surgery. Most patients are also required to attend alcohol treatment and AA. Once patients are able to complete these recommendations, they may be eligible for either deceased or living donor transplant. In the cases of hospitalized or urgent patients, as we said above, living donor transplant with a partial liver may not be the best option for them.
It’s important to remember that living donor liver transplant is putting a healthy person at risk with a major surgery. Donors go through a complete health evaluation, and they need to have time to think about their donation to be sure it is something they can and want to pursue. The doctors and care teams also need time to thoroughly evaluate both the donors and the recipients to be sure they are both safe enough to recover from surgery. For these and the reasons above, living donor liver transplant is not typically performed in urgent situations, but it can be a great option for those who have average MELD scores and are in need of a liver transplant to improve their quality of life.
Did you have living donor liver transplant surgery? Tell us about your experience with the process in the comments below.